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NURS 709 Pathophysiology > GI Disorders and Shock > Flashcards

GI Disorders and Shock Flashcards

1
Q

What are the causes of vomiting?

A

Stimulation of the medullary vomiting center or gastric/intestinal distension

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2
Q

What are the two distinct parts of the brain that control symptoms of vomiting?

A

Vomiting center
Chemoreceptor zone

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3
Q

What are the causes of dysphagia?

A

Neuro: Stroke
Structural: Cancer, autoimmune, achalasia

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4
Q

What are the manifestations of dysphagia?

A

Choking, Coughing, risk of aspiration

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5
Q

What is mallory-weiss syndrome?

A

Longitudinal tears in the esophagus from vomiting

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6
Q

In what demographic of patients do we see Mallory-Weiss syndrome?

A

Individuals with heavy alcohol intake

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7
Q

What is a hiatal hernia?

A

A prorusion of lower esophageal shpincter and part of stomach above the diaphram

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8
Q

What are the two forms of hiatal hernias?

A

Sliding
Rolling (paraesophageal)

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9
Q

Which hiatal hernia is worse?

A

Rolling (paraesophageal) because the stomach can become necrotic or food can become trapped inside

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10
Q

What are the manifestations of GERD?

A

Pyrosis usually 30-60 min after eating

Possible respiratory symptoms from aspiration of acid

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11
Q

What are some complications of GERD?

A

Strictures
Barrett Esophagus

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12
Q

What is a stricture?

A

Scar tissue
Smooth muscle spasms and edema may cause stenosis of lower esophageal sphincter

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13
Q

What is Barrett Esophagus?

A

Chronic inflammatory damage from acid exposure that leads to metaplasia of cells (Risk of cancer)

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14
Q

What is gastritis?

A

Inflammation of the gastric mucosa

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15
Q

What are the common causes of gastritis?

A

Aspirin
NSAIDS
Alcohol
Bacterial Toxins

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16
Q

How does H. Pylori cause gastritis?

A

The gram negative rods colonize the mucosal layer. Their flagella facilitate burrowing into the submucosa and the bacteria secretes urease, which buffers the surrounding acid

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17
Q

What is Peptic ulcer disease (PUD)?

A

Ulcer related disorders in the upper GI tract

Can develop in stomach or duodenum

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18
Q

What causes PUD?

A

NSAIDS
H. Pylori
GERD
Smoking

No Silly Green Hats

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19
Q

What are the manifestations of PUD?

A

Discomfort
Pain
Burning
Cramping
Gnawing quality

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20
Q

When are the manifestations of PUD normally felt?

A

When stomach or duodenum is empty

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21
Q

What are the complications of PUD?

A

Bleeding (esp if ulcer erodes deep in submucosa)
Hematemesis (vomiting of blood)
Melena (dark feces b/c of blood)
Perforation (high risk of peritonitis)
Outlet obstruction

Big Helmeted Men on Puppies

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22
Q

What is Irritable bowel syndrome?

A

Persistent or recurrent symptoms of intestinal dysfunction without physical abnormalities involving increased motility and intestinal contraction

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23
Q

Symptoms of IBS are normally relieved in what way?

A

By defecation

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24
Q

How may people have IBS?

A

10-15% of US pop
Women more than men

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25
Q

What is Inflammatory bowel disease?

A

Its a general term for two related inflammatory intestinal disorders-Crohn’s and Ulcerative Colitis

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26
Q

What are the shared characteristics of IBD (Crohn’s and Ulcerative Colitis)?

A

-Bowel inflammation
-Inflammatory Cell activation
-Remission/exacerbations
-Systemic Manifestations

BIRS

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27
Q

What are the causes of Crohn’s/Ulcerative Colitis?

A

Causitive agent is unknown, however there seems to be a familial occurance

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28
Q

How are Crohn’s and Ulcerative Colitis different?

A

Crohn’s: Normally more severe, affects small intestine and start of large intestine, causes patches of inflammation that damage multiple layers

Ulcerative Colitis: Primarily causes inflammation of rectum & colon, and inflammation is continious->only effects innermost layer

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29
Q

What are the manifestations of Ulcerative colitis?

A

-Chronic inflam. of colon
-Relapses marked by diarrhea with blood and mucous in stool
-Abdominal cramping
-Weakness
-Fatigue

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30
Q

What is a diverticulum?

A

Outpouching of a hollow structure of the body

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31
Q

What is Diverticulosis?

A

Diverticula are present in the colon but not inflamed

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32
Q

What is diverticulitis?

A

Inflammation with perforation of diverticula that causes pain and tenderness

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33
Q

What is appendicitis?

A

Inflammation of the 6-9 cm tubular pouch at the ileocecal junction

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34
Q

What are the signs and symptoms of appendicitis?

A

RLQ pain over 1-2 days
N/V
Rebound tenderness
Low grade fever
Leukocytosis

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35
Q

What is peritonitis?

A

Inflammation of the peritoneum that can be acute or chronic

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36
Q

What are the causes of peritonitis?

A

Ruptured appendix
Perforated ulcer
Penetrating abdominal wounds

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37
Q

What occurs during the initial infection in peritonitis?

A

Exudate with fibrin surrounds and isolates initial infection by forming adhesions

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38
Q

What occurs after initial infection in peritonitis?

A

More general problems occurs such as:
Paralytic ileus
Loss of F&E into caviyu
Tachycardia
Hypoension
WBC increase
Fever

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39
Q

A polyp in the colon can cause?

A

If it becomes malignant it can cause colon cancer

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40
Q

What are the manifestations of colorectal tumors? What is important to remember about these?

A

It is important to remember that tumors are usually present long term before causing manifestations of bleeding, change in bowel habits and pain

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41
Q

What are the tests for colon cancer?

A

Stool based testing
Colonoscopies

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42
Q

What are the manifestations of a bowel obstruction?

A

Pain
Constipation
Abdominal distension
FVD
Vomiting

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43
Q

What are the ‘mechanical’ bowel obstructions?

A

Hernias
Intussusception (inversion of one portion of intestine with another)
Post-op adhesions
Foreign bodies
Volvulus (twisting of intestine)

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44
Q

What are the ‘paralytic’ (Functional) types of bowel obstructions?

A

Occurs from neurogenic or muscular impairment and is common after abdominal surgery

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45
Q

What is hyperbilirubinemia?

A

Jaundice-bilirubin accumulation

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46
Q

What are the 3 cateogories than hyperbilirubinemia can be grouped into?

A

Pre-hepatic
Intra-hepatic
Post-hepatic

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47
Q

What can cause pre-hepatic hyperbilirubinemia?

A

Any RBC disorder causing excessive hemolysis

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48
Q

What are the causes of intrahepatic hyperbilirubinemia

A

viral hepatitis
alcoholic cirrhosis, primary biliary cirrhosis
drug induced jaundice alcoholic hepatitis

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49
Q

What are the causes of post-hepatic hyperbilirubinemia?

A

biliary obstruction by a stone in the common bile duct or by carcinoma of the pancreas.

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50
Q

What are the causes of hepatitis?

A

Viruses
Alcohol abuse
Drugs
Autoimmune conditions

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51
Q

Which are the most common types of viral hepatitis?

A

A
B
C

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52
Q

What is the transmission route for Hep A?

A

Fecal/Oral

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53
Q

What is the incubation period for hep A?

A

15-30 days

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54
Q

When are most individuals infectious with hep A?

A

in the first two weeks, overlapping with prodromial period

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55
Q

What are the signs and symptoms of hep A?

A

Acute onset of:
Nausea
Abdominal bloating
General malaise
Jaundice

Jackie Generally (has) No Abs

56
Q

Which forms of common viral hepatitis have a vaccine?

A

A, b

57
Q

What is the route of transmission of Hep B?

A

Parenteral
Transmission through sexual fluids

58
Q

Which type of effects does hep B have, acute or chronic?

A

Both

59
Q

What is the incubation period of hep B?

A

60-90 days

60
Q

25% of people with Hep B will progress to?
What about the people who don’t progress?

A

Cirrhosis and liver failures

The other 75% will still have latent hep B and are called carriers

61
Q

Which type of viral hepatitis is the most common cause of chronic hepatitis, cirrhosis and liver cancer?

A

Hep C

62
Q

What are the transmission routes for Hep C?

A

Bloodborne pathogens
IV drug use
Needle sticks
Small risk through receptive anal intercourse

63
Q

What is the incubation period of hep C?

A

6-12 weeks

64
Q

What type of symptoms normally appear with initial hep C infection?

A

Minimal symptoms

65
Q

20-25% of patients with hep C will?

A

Clear the infection

66
Q

What is the cure rate for hep C infection?

A

95%

67
Q

How is hep C normally discovered?

A

Through routine screening

68
Q

______ of alcohol is metabolized in the stomach, while __________ is metabolized in the?

A

20% in the stomach
80-90% in the liver

69
Q

What are the 3 stages of liver damage from alcohol?

A

Fatty liver disease -> Hepatitis->Cirrhosis

70
Q

What is fatty liver disease?

A

Accumulation of fat molecules within the hepatocytes that cause the liver to enlarge and develop a yellow color and shiny, greasy appearance

71
Q

What are the variables for fatty liver disease?

A

Amount of EtOH
Overall Diet
Amount of overall body fat

72
Q

What is alcoholic hepatitis?

A

Inflammation and necrosis of hepatocytes

73
Q

What are the signs and symptoms of alcoholic hepatitis?

A

Jaundice
Abdominal tenderness
Pain
Swelling
Nausea

74
Q

What is cirrhosis?

A

Chronic disease of the liver than can result from viral hepatitis, biliary disease, EtOH abuse

75
Q

What happens to the liver in cirrhosis?

A

Fibrosis and scarring occur
Abnormal liver cells regnerate
Nodules of varying size develop

76
Q

What do the cirrhosis fibroids and nodules interfere with?

A

General function
Scarred/Stiffness impairs blood flow
Hepatocytes are impaired

77
Q

Cirrhosis may progress to?

A

Functional liver failure
Portal hypertension

78
Q

What are the manifestations of cirrhosis?

A

Manifestations mostly due to circulatory congestion (portal hypertension) and reduced liver function

79
Q

What is portal hypertension?

A

Sustained elevated pressure in Portal vein >22mmHg

80
Q

What are the causes of portal hypertension?

A

Prehepatic: Venous clots in vein
Intrahepatic: Cirrhosis
Posthepatic: Blockage in hepatic vein, right sided heart failure

81
Q

What are the complications of Portal hypertension?

A

Ascities
Splenomegaly
Portosystemic shunts

A person the portal hypertension can have a swollen spleen, swollen belly and blood has to move around these.

82
Q

Ascities in a very late sign of portal hypertension, cirrhosis and liver failure. Why?

A

Because the liver isn’t functioning, decreased albumin lowers capillary oncotic pressure, while sustained pressure in portal vein pushes back into capillaries increasing capillary hydrostatic pressure. This pushing out causes 3rd spacing

83
Q

Why is splenomegaly a complication of portal hypertension?

A

Spleen enlargement can occur due to excess blood volume and pressure

Blood can also become congested and trapped

84
Q

Portosystemic shunts are a complication of portal hypertension. Why?

A

the collateral pathways/side channels occur because of increased pressure in the venous system.

Especially dangerous are esophageal varicies

85
Q

What are esophageal varicies?

A

Collateral pathways on the esophagous due to increased pressure in venous system.

Very dangerous if they rupture->considered an acute bleed.

86
Q

What is liver failure?

A

The end stage of various liver diseases that develops when the liver is at 10-20% capacity

87
Q

What are the hematological effects of liver failure?

A

Decrease in RBC and platelets

Clotting factors effected

88
Q

What are the endocrine effects of liver failure?

A

Glycogen production impaired
Bile production ceases
Androgen and estrogen hormones effected

89
Q

What are the dermatological effects of liver failure?

A

Visible jaundice of skin
Itching due to bilirubin buildup

90
Q

What is hepatic encephalopthy?

A

A complication of liver failure where ammonia builds up in blood and can enter the CNS causing liver related brain damage

91
Q

What are the risk factors for cholelithiasis (gallstones made of cholesterol)?

A

Increased concentration in bile
Female gender
Overweight
White
40’s

92
Q

What is cholesystitis?

A

Inflammation of the gallbladder often due to cholelithiasis

93
Q

What are the symptoms of cholesystitis?

A

PAIN
Vominting associated with eating (esp a meal with high fat content)

94
Q

What is acute pancreatitis?

A

Active pancreatic enzymes are released into the pancrease and surrounding tissue

95
Q

What are the common causes of acute pancreatitis?

A

Gallbladder issues
Excessive EtOH intake

96
Q

What are the symptoms of acute pancreatitis?

A

Severe, radiating abdominal pain and distension
Fluid may be lost into retroperitoneal cavity or abdomincal cavity

*Pts will be in fetal position

97
Q

What is chronic pancreatitis?

A

Gradual, permanent damage of pancreas tissue with repeated episodes similar to acute pancreatitis

98
Q

What is the most common cause of chronic pancreatitis?

A

Long term alcohol abuse

99
Q

The accumulated damage from chronic pancreatitis can eventually?

A

Permanently impair endocrine and exocrine function

100
Q

Shock is also known as?

A

Circulatory Failure

101
Q

Shock is?

A

An acute failure of the circulatory system to provide the body tissues with adequate blood supply/flow

102
Q

Shock results in?

A

Decreased perfusion of all body organs, tissues, and cells

103
Q

What do the manifestations of shock result from?

A

Hypoxic injury of tissues and organs and the compensatory mechanisms of the body

104
Q

Key features across all shock are?

A

Hypotension
Reduced BP
Low perfusion through body

105
Q

Cardiogenic shock is?

A

Reduction in cardiac function that begins at heart because the heart is failing to adequately pump blood.

106
Q

Hypovolemic shock is?

A

Loss of blood volume from fluid volume deficit->
An acute loss of 15-20% or greater IVF

107
Q

Obstructive shock is?

A

Blockage of blood flow through the circulatory system (ex: massive blood clot in circulatory system)

108
Q

Distributive shock is?

A

massive systemic vasodilation expands the vascular compartment such that blood volume cannot fill the space

(neurogenic, anaphylatic and septic)

109
Q

What are the signs of cardiogenic shock?

A

Decreased cardiac output and signs of decreased perfusion despite appropriate intravascular volume

Suddenly reduced EF%, CO and BP

110
Q

What are the most common causes of cardiogenic shock?

A

Myocardial infarction (stemi->effecting left ventricle)

Serious dysrythmias, cardiac tamponde, acute valve disorders

111
Q

What is one of the biggest manifestations of cardiogenic shock?

A

EDV (preload) keeps increasing as the heart (usually LV) fails.

112
Q

The manifestations of cardiogenic shock are similar to?

A

Acute heart failure

BP drop
Pulse pressure decrease
Crackles in lungs due to fluid
Neurologic changes
Decreased LOC

113
Q

What are the causes of Hypovolemic shock?

A

External or internal hemorrhage
Loss of plasma
Loss of ECF (ascities)
Excessive third spacing

114
Q

Compensations of hypovolemic shock are targeted towards _____________ and ____________.

A

Maintaining cardiac output

Maintaining blood volume

115
Q

Fluid Volume Deficit/Hypovolemic Shock symptoms:
Mild

A

Thirst
Increased HR
BP normal
Peripheral Vasoconstriction
Mild neuro changes
Dry mucous membranes

116
Q

Fluid Volume Deficit/Hypovolemic Shock symptoms:
Moderate

A

Weakened pulses
Decreased urine ouput
Tachycardia (significant)
Hypotension (worsening)
Hyperventilation
Apathy
Stupor

117
Q

Fluid Volume Deficit/Hypovolemic Shock symptoms:
Severe

A

Peripheral veins collapse
Severe hypotension
Cool, clammy skin
Little to no urine output
Coma

118
Q

Blood pressure is not always a reliable way to stage shock, but what is?

A

Hourly urine output is a better indicator of abdominal/central organ perfusion because the kidneys are one of the last places blood will be diverted

119
Q

What is the treatment of hypovolemic shock?

A

Restore plasma blood vol

120
Q

What are the two main causes of distributive shock?

A

Impaired or absent sympathetic NS function

Systemic release of vasodilator chemicals

121
Q

Causes of neurogenic distributive shock are?

A

Reduced or blocked sympathetic output

122
Q

Causes of anaphylatic distributive shock are?

A

A systemic type 1 reaction

123
Q

Causes of septic distributive shock are?

A

Systemic inflammatory response to severe infection

124
Q

The most common type of distributive shock is?

A

septic

125
Q

What is systemic inflammatory reponse syndrome (SIRS)>

A

A systemic inflammatory response often due to a bloodstream infection

126
Q

What are the criteria for SIRS?

A

Increased or decreased temp
Tachycardia
Tachypnea or hypocapnia
Leuopenia or leukocytosis
Elevated lactate level (due to anerobic metabolism)

127
Q

What is the progression from infection to septic shock?

A

Septicemia->SIRS->Severe sepsis->Septic shock

128
Q

Infection + SIRS=

A

Sepsis

129
Q

What is the most frequent cause of septic shock?

A

Gram negative bacteria infecion

130
Q

Signs of shock + confirmed septicemia =

A

Septic shock

131
Q

The gram negative circulatory infection which leads to sepsis causes?

A

Systemic vasodilation
Disruption of caogulation/anticoagulation cascades

132
Q

What are the early manifestations of septic shock?

A

Fever
Vasodilation
Warm skin
Mild tachypnea/resp.alkolosis
Neuro changes

133
Q

What are the later manifestations of septic shock?

A

Increased HR
Decreased BP
Decreased kidney function
Eventual multiple organ dysfuction if left untreated

134
Q

General Complications of Shock?

A

ALI/ARDS
Acute kidney injury
GI injury -lack of perfusion
DIC
MODS

135
Q

What is DIC?

A

Disseminated intravascular coagulation.

Very complex bleeding disorder that 50-60% of pts with septic shock get.

Bascially in some places they are clotting and some places they are hemorrhaging

NURS 709 Pathophysiology (5 decks)

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